Hip pain is one of the most frequent musculoskeletal complaints seen in primary care, orthopedics, and physical therapy settings. It can develop suddenly after injury, progress slowly due to wear and tear, or appear without an obvious trigger. Because hip pain can stem from many different structures, including joints, muscles, tendons, ligaments and nerves.
At HealthsureHub, we break down what ICD code is for hip pain, how the ICD-10 code M25.55 is used, why it is used so frequently, and how it impacts clinical care, medical billing, and insurance claims.
What Is the ICD-10 Code for Hip Pain?
The ICD-10 Code for hip pain is M25.55, and it is used to document pain localized to the hip joint when a specific underlying condition has not yet been identified. This code belongs to the ICD-10-CM (Clinical Modification) system, which standardizes how symptoms, diagnoses, and healthcare encounters are recorded across the medical system.
Using ICD-10 Code M25.55 allows providers to clearly communicate that hip pain is the primary reason for a visit, even when diagnostic workups are still in progress. This ensures that patient concerns are properly documented and that care can proceed without unnecessary delays.
What Does ICD-10 Code M25.55 Represent in Medical Documentation?
ICD 10 M25.55 represents hip pain as a symptom rather than a definitive diagnosis. In medical documentation, this distinction is important because it signals that the provider is recognizing the patient’s pain while continuing to investigate its cause.
Clinically, this code tells other providers, insurers, and care teams that hip pain has been observed, evaluated, and deemed significant enough to warrant medical attention. It also helps justify follow-up visits, imaging studies, referrals, or conservative treatments such as physical therapy.
Where Is Hip Pain Anatomically Located When ICD M25.55 Is Used?
When ICD M25.55 is used, hip pain typically refers to discomfort in or around the hip joint and its surrounding structures. Patients may describe pain in several overlapping areas, including:
- The groin or front of the hip, often associated with joint-related issues
- The outer hip, which may involve bursae or soft tissues
- The upper thigh or buttock region, where referred pain can occur
Because hip pain can radiate or feel diffuse, this code allows providers to capture the symptom without prematurely assigning a specific anatomical diagnosis. In some cases, symptoms documented under hip pain may originate from or overlap with spinal conditions, such as those classified under the code for lower back pain, where discomfort can radiate into the hip, buttock, or upper thigh.
Why Do Healthcare Providers Use a Non-Specific Code Like ICD M25.55?
Healthcare providers use non-specific symptom codes like ICD 10 M25.55 because symptoms often appear before a clear diagnosis is possible. Early visits may occur before imaging, lab work, or specialist evaluations are completed.
Using a symptom-based code supports timely care by allowing providers to:
- Document the patient’s complaint accurately
- Initiate treatment or pain management strategies
- Order diagnostic tests without delay
- Refer patients to specialists when appropriate
This approach ensures that patient care is not stalled simply because a definitive diagnosis has not yet been confirmed.
How Is ICD-10 Code M25.55 Used During the Diagnostic Process?
ICD 10 M25.55 is most commonly used during the initial and intermediate stages of the diagnostic process. It often appears in medical records while a provider is:
- Ordering X-rays, MRIs, or other imaging studies
- Monitoring whether hip pain improves, worsens, or changes over time
- Recommending physical therapy or conservative treatment
- Evaluating a patient’s response to medications or activity modification
As additional findings emerge, this code may be replaced with a more specific diagnosis that better reflects the underlying condition.
What Types of Symptoms Can Lead to the ICD-10 Code for Hip Pain?
A wide range of symptoms can lead to the use of ICD-10 Code M25.55. Patients may report:
- Dull or aching hip pain
- Sharp or stabbing discomfort with movement
- Morning stiffness or reduced flexibility
- Pain during walking, standing, or climbing stairs
- Limited range of motion or weakness
Because the code does not specify severity, duration, or cause, it can be applied across many patient experiences and clinical presentations.
Can ICD 10 M25.55 Be Used Alongside Other Codes?
Yes, ICD 10 M25.55 is frequently used alongside other ICD-10 codes to provide a more complete clinical picture. Providers may document hip pain in combination with codes related to:
- Difficulty walking or gait abnormalities
- Reduced mobility or functional limitations
- Joint stiffness or generalized joint symptoms
- Injury history or recent trauma
Using multiple codes together helps explain how hip pain affects daily function and supports more accurate clinical documentation and billing.
How Does ICD-10 M25.55 Support Medical Billing and Insurance Claims?
ICD-10 Code M25.55 plays a critical role in medical billing by clearly stating why a patient sought care. Insurers rely on this code to understand the reason for office visits, diagnostic testing, or therapeutic services.
When a definitive diagnosis is not yet available, M25.55 helps justify evaluations, follow-up appointments, and conservative treatments. Accurate use of this code reduces claim confusion and supports smoother reimbursement processes.
What Does ICD-10 Code M25.55 Mean for Patients Reviewing Their Records?
For patients reviewing their visit summaries or medical bills, ICD-10 Code M25.55 simply indicates that hip pain was documented during the encounter. It does not automatically suggest a serious or chronic condition.
In many cases, this code serves as a temporary placeholder while providers continue to assess symptoms, monitor progress, and determine next steps in care.
Is M25.55 Used in Primary Care, Orthopedics, and Physical Therapy?
ICD-10 Code M25.55 is widely used across healthcare settings, including primary care offices, orthopedic clinics, urgent care centers, and physical therapy practices. Its broad applicability makes it especially useful when multiple providers are involved in evaluating the same complaint.
This consistency helps ensure that hip pain is documented uniformly, regardless of where the patient receives care.
How Is the ICD-10 Code for Hip Pain Used in Local Healthcare Practices?
Local healthcare practices use ICD-10 Code M25.55 to maintain continuity as patients move between providers. Whether a patient starts care in urgent care and later sees a specialist or therapist, the code helps preserve a consistent medical narrative.
This shared documentation improves coordination, reduces duplicate testing, and supports clearer communication across care teams.
When Should M25.55 Be Replaced With a More Specific Code?
ICD-10 M25.55 is typically replaced once the underlying cause of hip pain has been identified. After diagnostic confirmation, providers may transition to codes that reflect conditions such as arthritis, tendon injuries, fractures, or other joint disorders.
More specific coding improves diagnostic accuracy, treatment planning, and long-term health record clarity.
Why Is ICD-10 M25.55 Important for Population Health and Data Tracking?
Beyond individual patient care, ICD-10 M25.55 supports population health analysis by tracking how often people seek treatment for hip pain. Aggregated data helps healthcare systems identify trends, allocate resources, and better understand the burden of musculoskeletal conditions. This information also contributes to research and public health planning efforts.
Conclusion
The ICD-10 Code for hip pain (M25.55) is a practical, symptom-based code used when hip pain is present but not yet fully diagnosed. It supports timely care, accurate documentation, and clear communication between patients, providers, and insurers.
Understanding ICD-10 Code M25.55 helps demystify medical records and reinforces that early symptom documentation is a normal and important part of the healthcare process.
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